Kevin D. H. Mitchell

The applicant was involved in a single-vehicle rollover accident and sought various statutory accident benefits from the respondent insurer.

The applicant's claim for a non-earner benefit was dismissed because she failed to submit a disability certificate within the 104-week time limit, and there was no evidence the respondent was aware of the accident to provide forms earlier.

The Tribunal found a proposed psychological assessment to be reasonable and necessary, as the respondent had already approved a psychological treatment plan based on it.

Claims for plastic surgery, orthopaedic, and driving rehabilitation assessments were dismissed as not reasonable and necessary.

The Tribunal awarded the applicant $220 under s. 10 of O. Reg. 664, finding the respondent unreasonably withheld approval of the psychological assessment while approving the treatment plan derived from it.

The applicant sought reconsideration of a decision denying him income replacement benefits beyond 104 weeks post-accident.

The applicant argued the adjudicator made errors of fact and law regarding his pre- and post-accident employment, medical restrictions, and the legal test for post-104 IRBs.

The tribunal found no errors of fact, noting the applicant returned to work at a reduced capacity and failed to provide medical evidence restricting him from working full-time.

The tribunal also found no error of law, as the adjudicator properly assessed the applicant's disability and employment competencies in a real-world setting.

The request for reconsideration was denied.

The Applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming that chronic pain syndrome prevented him from working full-time.

The Applicant had returned to his pre-accident role but at reduced hours.

The Respondent denied the IRBs, arguing the Applicant did not meet the post-104 test of suffering a complete inability to engage in suitable employment.

The Tribunal dismissed the application, finding that while the Applicant suffered from chronic pain, he had successfully returned to work at two-thirds capacity and maintained his status and reward.

The Tribunal preferred the Respondent's medical evidence that the Applicant was not medically restricted from working and would benefit from workplace accommodations and exercise.

The applicant was unsuccessful in her arbitration for accident benefits and was ordered to pay the insurer's expenses.

In this expense hearing, the insurer claimed over $44,000 in costs.

The arbitrator reduced the claimed amount, noting the applicant was self-represented and the insurer's claim was disproportionate to the amounts at issue.

The arbitrator awarded the insurer $14,928.26 in expenses for the main hearing but denied the insurer's request for the costs of the expense hearing itself.

The appellant appealed an arbitrator's decision dismissing claims for income replacement benefits, medical benefits, and a special award following a motor vehicle accident.

The Director's Delegate found no error of law, noting that the appellant failed to prove any qualifying income for the income replacement benefits and that uncontradicted expert evidence supported the denial of the medical benefits.

The appeal was dismissed, and the appellant was ordered to pay $2,800 in appeal expenses to the insurer.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to medical benefits and income replacement benefits.

The insurer denied the claims, arguing the applicant was self-employed with no net profits and that her injuries did not warrant further treatment.

The arbitrator found the applicant lacked credibility and accepted the insurer's expert evidence that her physical injuries had plateaued and her psychological issues were unrelated to the accident.

The arbitrator also determined the applicant was self-employed and had no profits, resulting in an income replacement benefit calculation of zero.

The application was dismissed, and the insurer was awarded its expenses.

The appellant insurer sought to appeal an arbitrator's preliminary decision which found that the respondent insured had sustained a catastrophic impairment following a motor vehicle accident.

The arbitrator based this finding on the respondent's Glasgow Coma Scale scores of 9 and a diagnosis of concussion, applying the binding legal test that the severity of the brain injury is irrelevant if the statutory GCS criteria are met.

The Director's Delegate rejected the interlocutory appeal, finding no strong grounds to depart from established case law and concluding that the most efficient resolution was to defer any appeal until all issues in the arbitration were finally decided.

The Delegate also refused to stay the arbitrator's order, noting the hardship a stay would cause the respondent whose minor injury benefits had been exhausted.

The applicant was injured in a motor vehicle accident and sought enhanced statutory accident benefits, claiming a catastrophic impairment based on three Glasgow Coma Scale (GCS) scores of 9.

The insurer denied the claim, arguing the applicant sustained only a minor injury and that the GCS scores were not caused by a brain impairment resulting from the accident.

The arbitrator found that the applicant sustained a concussion, which qualifies as a brain impairment, and that the impairment was caused by the accident.

Applying the Divisional Court's ruling in Hodges, the arbitrator held that the GCS score is conclusive and an inquiry into the seriousness of the brain injury is irrelevant.

The arbitrator concluded that the applicant sustained a catastrophic impairment within the meaning of the Schedule.

The applicant was injured while using a rented U-Haul truck.

He submitted an Application for Accident Benefits to U-Haul's insurer, Republic Western, which redirected the application to Wawanesa, the insurer of the applicant's daughter's vehicle.

Both insurers refused to adjust the claim, leading to a preliminary issue hearing to determine which insurer received the first completed application.

The arbitrator found that Republic Western was the first insurer to receive a completed application and that there was a sufficient nexus between the applicant and Republic Western.

Republic Western was ordered to adjust the claim pending any priority dispute resolution and was substituted as the respondent in the arbitration.